Is ventilator-associated pneumonia an independent risk factor for death?
Is ventilator-associated pneumonia an independent risk factor for death?
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DOI：
10.1097/00000542-200104000-00005
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发表时间：
2001-04-01
期刊：
影响因子：
8.8
通讯作者：
Papazian, L
中科院分区：
文献类型：
--
作者：
Bregeon, F;Ciais, V;Papazian, L
背景：呼吸机相关性肺炎（VAP）一直被认为是增加死亡率的原因。然而，尚不确定肺炎是否是死亡的原因，也不确定致命性结局是否由肺炎发作前存在的其他死亡风险因素引起。本研究的目的是评估归因于VAP所造成的死亡率进行配对，病例对照研究死亡的患者和患者出院后超过48小时的重症监护病房的机械ventilation.Methods：在研究期间，135例连续死亡病例组。病例对照匹配标准如下：（1）入院时诊断符合11个预定诊断组之一;（2）10年内的年龄差异;（3）性别;（4）入院1年内;（5）APACHE II评分在7分以内;（6）对照患者的通气时间至少与病例相同。精确的临床，放射学，和微生物的定义被用来识别VAP。结果：分析进行了108对匹配的成功率为91%。两组均发生VAP 39例（36.1%）。多因素分析显示，肾功能衰竭、骨髓衰竭和糖皮质激素治疗是死亡的独立危险因素，而不是VAP。有没有观察到的临床和微生物学诊断标准pneumonia.Conclusion：呼吸机相关性肺炎的病例和对照之间的差异似乎不是一个独立的死亡危险因素。
Background: Ventilator-associated pneumonia (VAP) has been implicitly accused of increasing mortality. However, it is not certain that pneumonia is responsible for death or whether fatal outcome is caused by other risk factors for death that exist before the onset of pneumonia. The aim of this study was to evaluate the attributable mortality caused by VAP by performing a matched-paired, case-control study between patients who died and patients who were discharged from the intensive care unit after more than 48 h of mechanical ventilation.Methods: During the study period, 135 consecutive deaths were included in the case group. Case-control matching criteria were as follows: (1) diagnosis on admission that corresponded to 1 of 11 predefined diagnostic groups; (2) age difference within 10 yr; (3) sex; (4) admission within 1 yr; (5) APACHE II score within 7 points; (6) ventilation of control patients for at least as long as the cases. Precise clinical, radiologic, and microbiologic definitions were used to identify VAP.Results: Analysis was performed on 108 pairs that were matched with 91% of success. There mere 39 patients (36.1%) who developed VAP in each group. Multivariate analysis showed that renal failure, bone marrow failure, and treatment with corticosteroids but not VAP were independent risk factors for death. There was no difference observed between cases and controls concerning the clinical and microbiologic diagnostic criteria for pneumonia.Conclusion: Ventilator-associated pneumonia does not appear to be an independent risk factor for death.